Cardiac Calcium Scoring

Test Overview

Cardiac calcium scoring uses a special X-ray test called computed tomography (CT) to check for the buildup of calcium in plaque on the walls of the arteries of the heart (coronary arteries). This test is used to check for heart disease in an early stage and to determine how severe it is. Cardiac calcium scoring is also called coronary artery calcium scoring.

The coronary arteries supply blood to the heart. Normally, the coronary arteries do not contain calcium. Calcium in the coronary arteries is a sign of coronary artery disease (CAD).

A CT scan takes pictures of the heart in thin sections. The pictures are recorded in a computer and can be saved for more study or printed out as photographs.

Cardiac calcium scoring is not done very often because a physical exam and other tests often give enough information about your heart. But if you are at medium risk for CAD based on your risk factors, cardiac calcium scoring may give your doctor more information to decide on your risk of CAD. Medium risk means that you have a 10% to 20% chance of having a heart attack in the next 10 years, based on your risk factors. You can be at medium risk and not have any symptoms of heart disease. Check your risk with this Interactive Tool: Are You at Risk for a Heart Attack?

If your doctor thinks that results from a cardiac calcium test could change your treatment for heart disease, your doctor may advise this test for you.

Cardiac calcium scoring is not advised for routine screening, because it can show that you may have plaque in your coronary arteries even if you do not have CAD. This is especially true if you have a low risk of CAD.

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  Heart disease risk: Should I have a coronary calcium scan?

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  Interactive Tool: Are You at Risk for a Heart Attack?

Why It Is Done

Cardiac calcium scoring is done to:

  • Find out if you have coronary artery disease (CAD).
  • Find out how severe your heart disease is.
  • Sometimes predict if you will get symptoms of CAD.

How To Prepare

You do not need to do anything before you have this test. But you may be asked to not smoke or not eat or drink anything that has caffeine for a few hours before your test.

You probably will not have this test if you have had a heart attack, coronary artery bypass surgery (CABG), or angioplasty. Also, the test usually is not for women who are or might be pregnant.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?) .

How It Is Done

A cardiac calcium scoring test is usually done by a radiology technologist. The pictures are usually interpreted by a radiologist. Other doctors, such as a family medicine doctor, internist, cardiologist, or surgeon, may also review a cardiac calcium scoring test.

You will need to remove any jewelry that might be in the way of the X-ray picture. You may need to take off some of your clothes. If so, you will be given a gown to use during the test. For some CT scans, you may be able to wear your clothes. If so, wear loose clothes that do not have zippers or snaps.

Small metal discs called electrodes will be put on your chest. Wires connect these to an EKG machine that records the electrical activity of your heart on paper. The EKG records when your heart is in the resting stage, which is the best time for the CT scans to be taken.

If your heart rate is 90 beats per minute or higher, you may be given medicine to slow your heart rate.

During the test, you will lie on a table connected to the CT scanner. The scanner is a large doughnut-shaped machine.

The table slides into the round opening of the machine and the scanner moves around your body. The table will move a little every few seconds to take new pictures. You may hear clicking or buzzing sounds as the table and scanner move.

You may be asked to hold your breath for 20 to 30 seconds while pictures of your heart are taken. It is very important to hold completely still while the pictures are taken.

During the test, you are usually alone in the scanner room. But the technologist will watch you through a window. You will be able to talk with the technologist through a two-way intercom.

A cardiac calcium scoring test takes about 30 minutes.

How It Feels

You won't have any pain from the X-rays during the cardiac calcium scoring test. But the table you lie on may feel hard and the room may be cool. You may find it hard to lie in one position for a long time.

Risks

The chance of cardiac calcium scoring causing a problem is small.

  • There is a slight chance of developing cancer from having cardiac calcium scoring. The chance is higher in people who have many radiation tests. If you are concerned about this risk, talk to your doctor about the amount of radiation this test may give you and confirm that the test is needed.
  • There is a slight risk that a CT scan can interfere with implanted or external medical devices. Examples of medical devices include pacemakers, insulin pumps, defibrillators, and neurostimulators.

Results

Cardiac calcium scoring uses a special X-ray test called computed tomography (CT) to check for the buildup of calcium in plaque on the walls of the arteries of the heart (coronary arteries). The radiologist may discuss initial results of the cardiac calcium scoring test with you right after the test.

Cardiac calcium scoring

Score

Presence of plaque

0

No plaque is present. You have less than a 5% chance of having heart disease. Your risk of a heart attack is very low.

1–10

A small amount of plaque is present. You have less than a 10% chance of having heart disease. Your risk of a heart attack is low. But you may want to quit smoking, eat better, and exercise more.

11–100

Plaque is present. You have mild heart disease. Your chance of having a heart attack is moderate. Talk with your doctor about quitting smoking, eating better, beginning an exercise program, and any other treatment you may need.

101–400

A moderate amount of plaque is present. You have heart disease, and plaque may be blocking an artery. Your chance of having a heart attack is moderate to high. Your doctor may want to do more tests and may start treatment for heart disease. Or he or she may start you on aggressive treatment for any risk factors such as high blood pressure and high cholesterol.

Over 400

A large amount of plaque is present. You have more than a 90% chance that plaque is blocking your arteries. Your chance of having a heart attack is high. Your doctor will want to do more tests and will start treatment.

High values

The higher your score on cardiac calcium scoring, the more plaque you have in the arteries of your heart. This makes your chance of having a heart attack higher.

If you have a high cardiac calcium score, you may need more tests to check if you have coronary artery disease (CAD) or to find out how severe it is, especially if you have other risk factors for CAD. Cardiac calcium scoring can show that you may have plaque in your coronary arteries even if you do not have CAD. So this test is not advised for routine screening for coronary artery disease.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

  • Having a fast heart rate.
  • Smoking.
  • Caffeine use.

What To Think About

  • Plaque that is not hard (soft plaque) cannot be found with cardiac calcium scoring. Soft plaque is the earliest form of damage to the arteries of the heart. If you have soft plaque in your arteries, the test may give normal results, but this is a false-negative result. The buildup of soft plaque Can also cause a heart attack.
  • Cardiac calcium scoring is not done very often because a physical exam and other tests can give information about your heart.
  • If your cardiac calcium scoring shows that you have a high chance of having heart disease, you can take steps to lower your chance. Eat better, quit smoking, and get more exercise. These are the same steps your doctor would recommend after looking at your health history, your physical health, and any lab tests, such as a cholesterol test. If you have high blood pressure or high cholesterol, talk to your doctor about your treatment choices.
  • It is possible to have false-positive test results. This means that the test shows a high chance of blockage in the arteries of the heart when it is not true. People with a low chance of heart disease are most likely to have a false-positive test. This test is not advised for routine screening for coronary artery disease.
  • Cardiac calcium scoring may not be covered by all health insurance plans.
  • Cardiac calcium scoring may not be available in some areas of the United States, such as in small towns.
  • Sometimes doctors automatically schedule routine tests because they think that's what patients expect. But experts say that routine heart tests can be a waste of time and money. For information, see Heart Tests: When Do You Need Them?

For more information, see:

Click here to view a Decision Point. Heart disease risk: Should I have a coronary calcium scan?

References

Other Works Consulted

  • Budoff MJ, et al. (2008). Computed tomography of the heart. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 577–606. New York: McGraw-Hill Medical.
  • Greenland P, et al. (2004). Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA, 291(2): 210–215.
  • Greenland P, et al. (2007). ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Circulation, 115(3): 402–426.
  • Kim KP, et al. (2009). Coronary artery calcification screening: Estimated radiation dose and cancer risk. Archives of Internal Medicine, 169(13): 1188–1194.
  • U.S. Preventive Services Task Force (2009). Using nontraditional risk factors in coronary heart disease risk assessment. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/uspstf09/coronaryhdrs.htm.

Credits

Author Robin Parks, MS
Editor Maria Essig
Associate Editor Tracy Landauer
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Updated May 21, 2009

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